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Archived: Speke Care Home (Residential) Good

Reports


Inspection carried out on 9 March 2018

During a routine inspection

We carried out an unannounced inspection of Speke Care Home on 9 March 2018. Speke Care Home is a purpose built two storey building situated in the Speke area of Liverpool. The home is registered to provide personal care for up to 49 older people and at the time of our visit the service was providing support for 10 people. At the time of inspection everyone was accommodated on the ground floor of the home.

Speke Care Home is a ‘care home’. People in care homes receive accommodation and nursing or personal care as single package under one contractual agreement. CQC regulates both the premises and the care provided, and both were looked at during this inspection.

The service had a manager who had been registered with CQC since March 2017. A registered manager is a person who has registered with the Care Quality Commission to manage the service. Like registered providers, they are ‘registered persons’. Registered persons have legal responsibility for meeting the requirements in the Health and Social Care Act 2008 and associated Regulations about how the service is run. At our previous inspection the service had been in the process of changing providers, during this inspection we saw that this had not taken place.

During our last inspection we had identified that there were issues with medicines, recruitment processes and care plans. At this inspection we saw that improvements had been made.

During our last inspection we had identified an issue with medication administration regarding recording of returned medications. On this inspection we saw an improvement and all records were in good order. Medicines were managed safely.

Care plans and risk assessments were person centred and they detailed how people wished and needed to be cared for. They were regularly reviewed and updated as required.

At our last inspection we met a representative of a company that was proposing to take over the management of the service but the manager told us that this company was no longer involved. Two other consultants were providing management support. The manager told us that the provider had not visited the home “for years”. We were unable to see how the provider had effective input or oversight of the service.

The registered manager and staff understood the requirements of the Mental Capacity Act 2005 (MCA). This meant they were working within the law to support people who may lack capacity to make their own decisions. We saw that people were supported to make their own decisions and their choices were respected.

There was a safeguarding policy in place and staff were aware of the safeguarding procedure in relation to safeguarding adults and all were aware of the need to inform the manager immediately.

There were a range of audits in place to assess and monitor the quality and safety of the service provided. Examples included, medication audits, infection control audit and premises checks. People’s views and opinions on the service provided were regularly sought. For example, there was evidence of satisfaction surveys being carried out.

There continued to be sufficient staff employed at the home to meet people’s care needs. The staffing levels were maintained when the number of people living in the home decreased. This contributed to the quality of the care being delivered.

The staff were friendly, welcoming and we observed good relationships were maintained with people living in the home and a kind and respectful approach to people’s care. The manager continued to be a visible presence in and about the home and it was obvious that she knew the people who lived in the home well.

Inspection carried out on 15 August 2017

During a routine inspection

We carried out an unannounced inspection of Speke Care Home on 15 August 2017. Speke Care Home is a purpose built two storey building situated in the Speke area of Liverpool. The home is registered to provide personal care for up to 49 older people and at the time of our visit the service was providing support for 15 people. At the time of inspection everyone was accommodated on the ground floor of the home.

The service had a manager who had been registered with CQC since March 2017. A registered manager is a person who has registered with the Care Quality Commission to manage the service. Like registered providers, they are ‘registered persons’. Registered persons have legal responsibility for meeting the requirements in the Health and Social Care Act 2008 and associated Regulations about how the service is run. The service was in the process of changing providers and we met the prospective new provider during the inspection.

The service had been placed in special measures following the previous inspections of the home. However, in response to the improvements that had been made we took the home out of special measures.

Staff who administered medication had been medication trained. The majority of medication records were completely legibly and properly signed for, however we found some areas for further improvement.

For the most part, appropriate recruitment processes and checks had been made before new staff started working at the home. However, the references obtained for one new staff member did not match what was on their application form. We also saw that not all induction records had been completed by new staff at the beginning of their employment.

The décor in the home was tired and dated and in need of refurbishment. For example, we saw poor quality curtains and old furniture that needed replacing. It was very hot in some rooms and the registered manager told us that they were not able to adjust the heating or turn off individual radiators.

Each person had an individual care file that contained an assessment of the person’s needs. These were written in a person-centred style, however we saw that there was a poor assessment form that was inappropriate and impossible for staff to complete in any meaningful way. Some information was long-winded and repetitive.

The policies for the home were in need of updating to ensure the staff had appropriate guidance for working in the home.

The Mental Capacity Act 2005 and the associated Deprivation of Liberties Safeguards legislation had been adhered to in the home. The provider told us that some people at the home lacked capacity and that a number of Deprivation of Liberty Safeguard (DoLS) applications had been submitted to the Local Authority in relation to people’s care. We found that in applying for these safeguards, people’s’ legal right to consent to and be involved in any decision making had been respected.

There were enough staff employed at the home to meet people’s care needs. The staff were friendly, welcoming and had good relationships with people living in the home and a kind and respectful approach to people’s care. The manager was a visible presence in and about the home and it was obvious that she knew the people who lived in the home well.

We spoke with the registered manager and she was open and honest and told us that she was committed to delivering a quality service. One person who lived at the home told us they felt safe at the home. They had no worries or concerns. People’s relatives also told us they felt their family members were safe.

Infection control standards at the home were good and standards were monitored and managed. Maintenance records were up to date and legible, this meant the home was a safe environment. The registered manager had systems in place to ensure that people were protected from the risk of harm or abuse. The home had quality assurance processes including audits and satisfaction questionnaires.

People had access to suffic

Inspection carried out on 17 August 2016

During a routine inspection

At our inspection on 20 and 24 April 2015 we identified that the service had a number of breaches of regulations. The service was rated inadequate.

We undertook a comprehensive inspection on the 19 October 2015. Our inspection visit was unannounced. During this visit we followed up the breaches identified during the April 2015 inspection. We found that the provider had made improvements in some areas but we also found a number of breaches of the Health and Social Care Act 2008 (Regulated Activities) Regulations 2010. We found breaches of Regulations, 9, 11, 12, 17 and 18 of the Health and Social Care Act 2008 (Regulated Activities) Regulations 2014 remained.

We undertook a further inspection on the 19 and 20 May 2016. Our inspection visit was unannounced. During this visit we followed up the breaches identified during the April 2015 and October 2015 inspections. We found that the provider had made improvements in some minor areas. We also found a number of continued breaches of the Health and Social Care Act 2008 (Regulated Activities) Regulations 2014. We found breaches of Regulations, 9, 11, 12, 17 and 18 of the Health and Social Care Act 2008 (Regulated Activities) Regulations 2014 remained. The service was again rated inadequate.

We undertook this inspection to follow up the breaches identified at the May 2016 inspection. We found the breach of Regulation 11 had been met but the breaches of Regulations 9, 12, 17 and 18 remained and we identified a new breach of Regulation 14 of the Health and Social Care Act 2008 (Regulated Activities) Regulations 2014.

A registered manager is a person who has registered with the Care Quality Commission to manage the service. Like registered providers, they are ‘registered persons’. Registered persons have legal responsibility for meeting the requirements in the Health and Social Care Act 2008 and associated Regulations about how the service is run. The home required a registered manager but there was not one currently in post. The last registered manager left the home in January 2015.

We found concerns with the safe storage of medicines as the temperatures of the storage areas were not properly monitored. We also found concerns with the way that risks were monitored in the home.

We found that staffing levels were not adequate to safely meet the needs of the people who lived in the home.

The home had improved the way that it monitored people’s needs under the Mental Capacity Act 2005. Deprivation of Liberty Safeguard (DoLS) applications had been made to the local authority and staff had a better understanding of the issues as they had been trained.

Nutrition and hydration management was found to be unsafe and people were at risk of not receiving prescribed nutritional supplements.

Care was provided by staff who knew the people who lived in the home and how they liked to be supported. We observed warm, positive interactions and people were happy with the care that they were receiving.

We found that the practices in the home were not adequately audited or monitored and that the management and provider oversight in the home did not provider safe or effective care.

The overall rating for this service is 'Inadequate' and the service therefore remains in 'special measures'.

Services in special measures will be kept under review and, if we have not taken immediate action to propose to cancel the provider's registration of the service, will be inspected again within six months. The expectation is that providers found to have been providing inadequate care should have made significant improvements within this timeframe. If not enough improvement is made within this timeframe so that there is still a rating of inadequate for any key question or overall, we will take action in line with our enforcement procedures to begin the process of preventing the provider from operating this service. This will lead to cancelling their registration or to varying

the terms of their registration within

Inspection carried out on 19 May 2016

During a routine inspection

At our inspection on 20 and 24 April 2015 we identified that the service had a number of breaches of regulations. The service was rated inadequate.

We undertook a comprehensive inspection on the 19 October 2015. Our inspection visit was unannounced. During this visit we followed up the breaches identified during the April 2015 inspection. We found that the provider had made improvements in some areas but we also found a number of breaches of the Health and Social Care Act 2008 (Regulated Activities) Regulations 2010. We found breaches of Regulations, 9, 11, 12, 17 and 18 of the Health and Social Care Act 2008 (Regulated Activities) Regulations 2014 remained.

We undertook this inspection on the 19 and 20 May 2016. Our inspection visit was unannounced. During this visit we followed up the breaches identified during the April 2015 and October 2015 inspections. We found that the provider had made improvements in some minor areas. We also found a number of continued breaches of the Health and Social Care Act 2008 (Regulated Activities) Regulations 2014. We found breaches of Regulations, 9, 11, 12, 17 and 18 of the Health and Social Care Act 2008 (Regulated Activities) Regulations 2014 remained.

Speke Care Home provides accommodation for people who do not require nursing care. It is a privately owned service which provides accommodation for up to 49 adults. The service is located in the Speke area of Merseyside. At the time of the inspection, 20 people lived in the service, as an agreement was in place that the service does not admit any new people until improvements had been made and sustained.

There was no registered manager of the home at the time of our inspection. A registered manager is a person who has registered with the Care Quality Commission to manage the service. Just as registered providers, they are ‘registered persons’. Registered persons have legal responsibility for meeting the requirements in the Health and Social Care Act 2008 and associated Regulations

about how the service is run.

Although we found improvements that are outlined in this report, we also found some similar concerns to those we identified at our last inspections.

People who lived in the service were offered their medicines in a safe way and at the right times. However, staff took no action to ensure the well-being of people who consistently declined their medicine. Issues with two people’s medication meant that the use of medicines remained unsafe. Staff did not have adequate information to administer medicine safely to these two people in an emergency situation. A small number of medicines were inadequately labelled by the supplying pharmacy. Staff had not sought clarification so as to make sure they gave the medicine safely. This placed people at risk of harm.

Arrangements to ensure that people received the correct medicines had improved and the storage, and timing of medicines had also improved however issues with two people’s medication meant that the way in which medication was managed remained unsafe. We saw that there were medicines were no clear instructions available for staff to give medicines safely. Where instructions were available, staff were not competent to administer. This placed people at risk of harm.

The service was not consistently respecting and involving people who use services in the care they received. The provider had started to implement a new care plan and assessment record from May 2016. We looked at six care plans and for example, only two of the care plans had been updated but still did not have all of the persons details in place.

Staff members were not always following the Mental Capacity Act (2005) for people who lacked capacity to make decisions. For example one person’s Deprivation of Liberty (DoLS) was out of date and had expired 28 April 2016. This meant that the person may have since been deprived of their liberty unlawfully. People’s mental capacity had not always been assessed and there was

Inspection carried out on 19 October 2015

During an inspection to make sure that the improvements required had been made

At our last inspection of 20 and 24 April 2015 we identified that the service had a number of breaches of regulations.

We undertook this comprehensive inspection on the 19 October 2015. Our inspection visit was unannounced. During this visit we followed up the breaches identified during the April 2015 inspection. We found that the provider had made some improvements. We also found a number of breaches of the Health and Social Care Act 2008 (Regulated Activities) Regulations 2010. We found breaches of Regulations, 9, 11, 12, 17 and 18 of the Health and Social Care Act 2008 (Regulated Activities) Regulations 2014 remained.

Speke Care Home (Residential) provides accommodation for people who do not require nursing care. It is a privately owned service which provides accommodation for up to 49 adults. The service is located in the Speke area of Merseyside. At the time of the inspection, 24 people lived in the service, as an agreement was in place that the service does not admit any new people until improvements have been made and sustained.

There was no registered manager of the home at the time of our inspection. A registered manager is a person who has registered with the Care Quality Commission to manage the service. Just as registered providers, they are ‘registered persons’. Registered persons have legal responsibility for meeting the requirements in the Health and Social Care Act 2008 and associated Regulations about how the service is run.

Although we found improvements that are outlined in this report, we also found some similar concerns to those we identified at our last inspection.

People who lived in the service did not consistently receive their medicines in a safe manner that met their individual needs. Staff did not have the correct information or training to give medicines when needed and this meant that people would not be able to receive their medicines safely.

Arrangements to ensure that people received the correct medicines had improved however, the storage, administration and timing of medicines remained unsafe. We saw that there were medicines were no clear instructions were available for staff to give medicines safely. Where instructions were available, these had not always been correctly followed. This placed people at risk of harm.

The service was not consistently respecting and involving people who use services in the care they received. For example, all but one of the care plans viewed did not show the person’s choices and personal preferences. Where information was included this was limited and did not provide staff with a full understanding of peoples personal preferences or choices. The care plans viewed did not involve the person or their relative when they were. People told us they had no input into the menus or activities.

Staff members were not always following the Mental Capacity Act (2005) for people who lacked capacity to make decisions. For example people’s mental capacity was not assessed and there was no information available in the service for the staff that helped them support a person with fluctuating capacity.

We saw that people’s health care needs were not accurately assessed and that risks such as poor nutrition were not consistently correctly calculated. People’s care was not planned or delivered consistently. In some cases, this put people at risk and meant they were not having their individual care needs met. Records regarding care delivery were not checked as accurate or up to date leaving people at risk of not having their individual needs monitored or met.

We found that there were concerns regarding the management of risk in the service. The fire risk assessment only identified significant risks and did not detail how the risks had been identified. Actions detailed had not all been met.

Suitable arrangements were not in place that addressed people’s needs and ensured their consent to the care they received was appropriately obtained. Staff we spoke with had a limited understand of what their role was and their obligations were in order to maintain people’s rights.

Staff told us they did feel supported by the new manager. They said they had been sufficiently trained. We saw from staff files, that staff had not received appropriate appraisals and supervision. Staff training was underdeveloped with large gaps in the training of staff particularly around dementia care needs, medicines training, mental capacity, moving and handling and safeguarding.

The service was not well led. The provider did not have effective systems in place to identify the risks to people’s health, welfare and safety and failed to seek people’s views on the quality of the service they received.

The provider’s staff recruitment practices had improved. We saw that staff received appropriate checks before they started working in the service. However, references were not validated to make sure they were genuine before staff started working in the service.

The Care Quality Commission (CQC) monitors the operation of the Deprivation of Liberty Safeguards (DoLS) which applies to care homes. We found that where required not all the necessary DoLS applications had been made. The manager was progressing the applications for DoLS.

We saw that the management of nutrition had improved and the budget for food available in the service had increased. Picture menus had been implemented and the kitchen staff were fully aware of special diets.

The reporting and addressing of safeguarding had increased and records were available that showed that safeguarding and complaints were investigated and addressed.

Staffing levels had significantly increased and the positive impact of these was evident. Staff were unrushed and able to communicate effectively with people living in the service.

People living in the service, staff and relatives reported that they thought improvements had been made and that quality of care provision had been increased.

As the overall rating for this service was ‘Inadequate’ the service is therefore in 'Special Measures'. The service will be kept under review and, if we have not taken immediate action to propose to cancel the provider’s registration of the service, will be inspected again within six months. The expectation is that providers found to have been providing inadequate care should have made significant improvements within this timeframe.

Inspection carried out on 23 June 2015

During an inspection to make sure that the improvements required had been made

We carried out an unannounced comprehensive inspection of this service on the 20 and 24 April 2015. At this inspection breaches of legal requirements were found.

We are taking enforcement action against the provider because of continuing breaches in the care provided. We will report on this action when it is completed.

We undertook this focused inspection on the 23 June 2015 due to receiving concerning information. This report only covers our findings in relation to these topics. You can read the report from our last comprehensive inspection on the 20 and 24 April 2015, by selecting the 'all reports' link for ‘ Speke care Home (Residential)’ on our website at www.cqc.org.uk’

Speke Care Home (Residential) provides accommodation for persons who do not require nursing care. It is a privately owned service which provides accommodation for up to 49 adults. There are currently 27 people living there. The service is located in the Speke area of Merseyside.

There was no registered manager of the home at the time of our inspection. A registered manager is a person who has registered with the Care Quality Commission to manage the service. Like registered providers, they are ‘registered persons’. Registered persons have legal responsibility for meeting the requirements in the Health and Social Care Act 2008 and associated Regulations about how the service is run.’

We found a number of continued breaches of regulations relating to safeguarding people, administration of medicines, nutrition management, poor staffing levels and the need for consent.

Inspection carried out on 20 and 24 April 2015

During a routine inspection

At our last inspection in December 2014, we identified breaches of legal requirements. We issued the provider with four warning notices in relation to these breaches. The breaches related to Regulation 9, Care and welfare; Regulation 10, Quality monitoring. Regulation 11, Safeguarding and Regulation 13, the Management of medicines of the Health and Social Care Act 2008 (Regulated Activities) Regulations 2010. The warning notices advised the provider that further enforcement action would be taken unless they complied with the requirements of the regulations by the 15 February 2015.

We undertook this comprehensive inspection on the 20 and 24 April 2015. Our inspection visit was unannounced. During this visit we followed up the breaches identified during the December 2014 inspection. We found that the provider had not taken the appropriate action.

During this inspection we found breaches of Regulations, 9,11,12,13,14,16,17 and 18 of the Health and Social Care Act 2008 (Regulated Activities) Regulations 2014.

Speke Care Home (Residential) provides accommodation for people who do not require nursing care. It is a privately owned service which provides accommodation for up to 49 adults. The service is located in the Speke area of Merseyside.

There was no registered manager of the home at the time of our inspection. A registered manager is a person who has registered with the Care Quality Commission to manage the service. Like registered providers, they are ‘registered persons’. Registered persons have legal responsibility for meeting the requirements in the Health and Social Care Act 2008 and associated Regulations about how the service is run.’

We found similar concerns to those we identified at our last visit with regards to the management of medicines at the home. Storage, administration and record keeping were all unsafe. We saw that there were not clear instructions available for staff to give medicines. Where instructions were available these had not been correctly followed. This placed people at significant risk of harm.

People told us they felt safe with staff and this was confirmed by their relatives. The provider and staff had an understanding of safeguarding, however they did not at all times respond appropriately. We found three incidences where the provider had not responded appropriately to allegations of abuse. This meant people were not safeguarded against the risk of abuse.

Accidents and incidents were not properly recorded or monitored to ensure that appropriate action was taken to prevent further incidences.

People and their relatives told us the home was short staffed. Staff confirmed this view. We saw that staff were too busy tending to people’s personal care needs to interact socially with them or meet all of their assessed needs. This placed people’s health, welfare and safety at significant risk.

We looked at records relating to the safety of the premises and its equipment. We found concerns with the records produced by the manager. The fire risk assessment did not identify significant risks or detail what actions needed to be taken to minimise the risks of a fire.

The provider’s staff recruitment practices had improved. During this inspection we found that adequate improvements had been made to comply with the regulation that had been previously breached.

Staff told us they did feel supported by the new manager. They said they had been sufficiently trained. We saw from staff files, that staff had received appropriate appraisals and supervision. Records for staff training were not up to date and staff had not received the Mental Capacity Act (2005) training or understood the reason for its implementation in the home. The manager and deputy manager told us that staff were not fully competent in their roles and understood that the training programme was not up to date.

The provider had not complied with the Mental Capacity Act 2005 and Deprivation of Liberty Safeguards and its associated codes of practice in the delivery of care. Suitable arrangements were not in place that addressed people’s needs and ensured their consent to the care they received was appropriately obtained . Staff we spoke with had a limited understand of what was their role was and their obligations where in order to maintain people’s rights.

Care records did not adequately assess people’s needs or risks or plan how to meet their needs. Care records were not up to date and people’s care had not been updated when reviewed. Care planning for people living with dementia was not up to date and did not take into account that the people were unable to consent.

The service was not well led. The provider did not have effective systems in place to identify the risks to people’s health, welfare and safety and failed to seek people’s views on the quality of the service they received. The culture at the home was not open or transparent and staff were not supported or responded to appropriately by the provider. We discussed the issues we had identified at this inspection with the provider and expressed our concerns. We found a lack of accountability and responsibility by the provider in the acknowledgement of any of the concerns we raised.

Inspection carried out on 19 and 20 November 2014

During a routine inspection

Speke Care Home (residential) accommodates older people who do not need nursing care. On the date of our inspection 35 people were living in the service. The service can accommodate up to 49 people. The service has voluntary agreement not to admit any new service users until improvements are made.

We carried out this inspection to check if improvements had been made from the previous inspections of 31 March 2014 and 25 July 2014. We found that some improvements had been made. However there were a number of concerns that the service had not yet addressed.

This unannounced inspection took place on 19 and 20 November 2014. We had asked the provider to make improvements in staff support, monitoring the quality of the service, meeting people’s health and welfare needs, infection control and records. During this inspection we looked to see if these improvements had been made, but they had not all been completed.

We found a number of breaches of the Health and Social Care Act 2008 (Regulated Activities) Regulations 2010. You can see what action we told the provider to take at the back of the full version of this report.

Peoples view’s about the service they received were mixed. While some people were very happy, others were not. In addition, our observations and the records we looked at did not always match the positive descriptions some people had given us.

During the inspection, we spoke with thirteen people living at the service, five relatives, eight staff, the registered manager and the registered provider. A registered manager is a person who has registered with the Care Quality Commission to manage the service. Like registered providers, they are ‘registered persons’. Registered persons have legal responsibility for meeting the requirements in the Health and Social Care Act 2008 and associated regulations about how the service is run.

The service was not consistently respecting and involving people who use services in the care they received. For example all the care plans viewed did not show the person’s choices and personal preferences. The care plans did not involve the person or their relative when they were written and their views were not reflected in the care plans. People told us they had no input into the menus or activities and we saw that no choice of meals were offered.

Staff members were not always following the Mental Capacity Act (2005) for people who lacked capacity to make decisions. For example people’s mental capacity was assessed once only and there was no information available in the service for the staff that helped them support a person with fluctuating capacity. We saw inconsistent approaches from staff with some staff explaining to people before they undertook a care process, other staff failed to give the person any information about the care and support they were about to deliver.

We saw that people’s health care needs were not accurately assessed and that risks such as poor nutrition were not correctly assessed. People were not always supported to eat and drink enough to meet their nutrition and hydration needs. We saw that one person had lost a significant amount of weight but this had not been recognised by the service. As a result relevant professionals had not been contacted and appropriate measures to prevent any further weight loss had not been put into place. People’s care was not planned or delivered consistently. In some cases, this put people at risk and meant they were not having their individual care needs met. Records regarding care delivery were not consistently accurate or up to date leaving people at risk of not having their individual needs monitored or met.

Neither the registered manager nor the registered provider investigated or responded to people’s complaints in accordance with their own policy. Six of the people we spoke with did not know how to make a complaint. Two people told us they had made a complaint but felt that the situation had not improved.

Staff members were able to explain in detail how they reported any safeguarding concerns. When we looked at how staff put this into practice, we saw that three safeguarding concerns had not been recognised by the staff or reported to the registered manager. As a result the registered manager had been unable to appropriately report the concerns or review the incidents to prevent a re-occurrence. The lack of reporting safeguarding concerns appropriately potentially placed people who lived in the service at risk.

People who lived in the service did not consistently receive their medicines in a manner that met their individual needs. Staff did not have the correct information to give medicines when needed and this meant that at least one person did not receive their pain relief when needed.

Staff training had improved however there remained large gaps in the training of staff particularly around dementia care needs, communication and dealing with challenging behaviour. The majority of staff had been appropriately checked before starting work with the exception of one member of staff who had not been checked for their suitability to work in the service. The provider did not have a system to assess staffing levels and make changes when people’s needs changed. This meant they could not be sure that there was enough staff to meet people’s needs.

The arrangements that the provider had in place to check on the quality of the service had improved. Overall there were still gaps in the providers’ arrangements which meant service users’ views or their relatives did not influence the service provided and complaints were not appropriately addressed or responded to.

Inspection carried out on 25 July 2014

During an inspection to make sure that the improvements required had been made

This inspection was undertaken to follow up on previous enforcement action and outcomes that were identified at the previous inspection as non-complaint with the regulations.

As part of this inspection, we spoke with 12 people who lived at the home, three relatives, the manager, six staff and the local authority.

Is the service safe?

The majority of people, relatives and staff we spoke with told us that staffing levels at the home had improved and this had, had a positive impact on the service.

On our previous inspection of the service in 31 March 2014, we found the premises were not entirely suitable to maintain the safety of people living in the service. We asked the provider to submit an action plan outlining the improvements they intended to make. We found during this visit, although some progress had been made, it was insufficient.

We saw that additional concerns were identified at this inspection. There were a number of malodorous areas, cracked glass in windows, out of date fire risk assessment and a smoking area that had not been assessed for safety. We contacted the Fire Authority following our inspection, who attended the service at our request.

We also found serious shortfalls in the cleanliness and management of the home�s facilities and equipment.

Is the service effective?

On our previous visit to the home in 31 March 2014, we found the provider�s arrangements to monitor the service and provide quality of care were not effective. Enforcement action was taken. At this inspection we found that the additional staff had increased the staff�s ability to deliver care on a daily basis. We also found that systems to monitor the quality of the service overall had not improved sufficiently to increase and sustain any improvements.

The majority of people and relatives we spoke with said staff were kind and understood their needs. We found that the staff we spoke with demonstrated a good knowledge of people�s needs and the care they required. People told us that improvements had been made following the increase of staff.

Is the service caring?

On our previous visit to the home in 31 March 2014, we found peoples care was not always effectively planned or actions taken to deliver care that met people�s needs. At this inspection we saw that some improvements in the planning of care had been made. We did see that an increase in staffing numbers meant the staff had more time to deliver care.

Most of the people we spoke with said staff were kind and treated them with dignity and respect. One person raised concerns about the attitude of a member of staff, we discussed this with the manager and requested that a safeguarding referral was made. Following the inspection we rang the registered manager who told us a safeguarding referral had been made.

Is the service responsive?

On our previous visit to the home in 31 March 2014 we saw that the people living in the service had expressed dissatisfaction with the activities that were available. We asked the provider to submit an action plan outlining the improvements they intended to make.

We found during this inspection that insufficient progress had been made. People�s dissatisfaction with the range of social activities was still evident and there was limited evidence that people�s social and activity needs were met.

Is the service well led?

The service has a manager registered with CQC. We reviewed the quality monitoring audits that were undertaken to monitor the quality and safety of the service provided. We found the audits identified the risks or shortfalls in the homes performance. There were no arrangements in place to address these identified shortfalls.

The provider�s had not sent out surveys to people living in the service to obtain their views or opinions of the care they had received. They had sent out surveys to relatives and had received four although generally positive all stated that there were not enough activities. There were no plans in place to action this or to survey people who lived in the home, in order to obtain their opinion. We saw copies of the minutes of meetings we were unable to evidence how often the meetings were held, how people were informed of the meetings or the contents of the meeting or what actions were taken as a result of communicating with people and staff.

We were introduced to an individual by the registered manager and told that they were the homeowner. This person was not the registered provider or manager we have requested that the provider clarifies the role of the person we were introduced to as the home owner.

Inspection carried out on 31 March 2014

During an inspection in response to concerns

We carried out this inspection visit in response to information of concern which we had received regarding this service.

The findings of our inspection are based on our observations and the views of people who used the service, relatives and staff. We found that staff on both the residential and EMI units were very busy in trying to meet the needs of the people who used the service and as a result people were left unattended in the communal areas for long periods of time. Therefore, people who used the service were at risk of not receiving the care and support they required as staff were not readily available to observe them and meet their needs.

We found that people who use the service staff and others are not protected from the risk of unsafe or unsuitable premises. We also found that the provider did not have effective systems in place to assess and monitor the quality of the service provision.

Inspection carried out on 14 January 2014

During an inspection to make sure that the improvements required had been made

We had previously inspected Speke Care Home in July 2013 and found a number of areas of non-compliance. During this visit we found that there had been improvements at the service since our last inspection.

Speke Care Home provided people who used the service and their families with sufficient and appropriate information about their support and treatment to enable them to make informed decisions.

We found that people were protected from the risks associated with medicines because the provider had made changes to ensure that appropriate arrangements were in place to manage medicines.

During our previous inspection we had concerns over the management and recording of safeguarding incidents. We found during this inspection, that improvements had been made relating to the recording and reporting of safeguarding incidents.

We found that the service had implemented an effective system to identify, assess and manage risks to the health safety and welfare of people who used the service and others.

Inspection carried out on 21 July 2013

During an inspection in response to concerns

We spoke with visiting relatives of people living within both units at the service; they gave us good feedback about their relatives care and support. People's comments included; "They do a good job." Another person told us �She's lived here a long time, it's a good place."

People told us that they had felt safe living at Speke Care Home and we found that staff were aware of how to identify and report potential safeguarding occurrences. However we found that records relating to protecting people were not sufficiently robust.

The provider did not follow clear procedures in practice, which were monitored and reviewed relating to the storage and disposal of medicines.

The provider did not have a quality monitoring policy and system in place. Some auditing of the service had been undertaken but processes were not robust enough and left gaps which created risks for the people who used this service.

Inspection carried out on 22 November 2012

During a routine inspection

We spoke with a range of people about the service. We did this to gain a balanced overview of what people experienced. The people we spoke to included, the registered provider, the service manager, staff members, people who lived at the service, family members and a visiting health professional.

This service cares for people with a range of dementia conditions and conversation with some of the residents was limited due to their dementia condition. We therefore spent much of the time in the communal areas making observations of how people were being cared for.We observed staff assisting people who required care and support with personal care. We saw that staff treated people with respect and ensured their privacy when supporting them. They provided support or attention as people requested it. We spoke with one person about the care and support they received. They said they were happy living at the service and said that staff were polite and kind.

Reports under our old system of regulation (including those from before CQC was created)